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Proficiency in federal and state regulations (DOH, Medicaid/Medicare) and familiarity with third-party payers and managed care principles. Job Summary: As a Utilization Management Nurse/Social Worker, you'll play a crucial role in our multidisciplinary team, ensuring that patients progress seamlessly through their care journey according to appropriate admission statuses.
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The AVP will play a key leadership role on the HQRI team, partnering directly with the HQRI leadership team, leaders across the enterprise, including Market leadership, and external companies to create Medicare Risk Adjustment strategies to support Humana's industry leading position.
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2 - 3 years: Two years (three years, if LPN) in long term care and assisted living, including working knowledge of case management/ clinical work, Medicare /Managed care and Managed Medicaid protocols.
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Assist individuals with related matters including eligibility for benefits through Medicaid, Medicare, Social Security, and private insurance. Develop a plan of care for each individual to include services such as advocacy/case management, independent living skills, training, peer support, physical therapy, cognitive therapy, etc.
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Reconcile outstanding pending case requirements and requests for additional information while communicating regularly with our agent.
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Experience with eligibility and application process for various government sponsored benefits such as food stamps, Medicaid, Medicare savings programs. Department: Marketing Reports to: Department Administrator.
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Under guided supervision, the Audit and Reimbursement III will gain experience on complex issues involving the Medicare cost report and Medicare Part A reimbursement. The Audit and Reimbursement III will support our Medicare Administrative Contract (MAC) with the federal government (The Centers for Medicare and Medicaid Services (CMS) division of the Department of Health and Human Services.
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Experience in Risk-based arrangements and Value-Based care in government services (Medicare Advantage, Medicaid, ACA)Proven negotiation skills including extensive experience leading Medicare advantage percent of premium/delegation dealsAbility to manage multiple priorities, and leading multiple complex negotiations at a timeAdept at execution and delivery (planning, delivering, and supporting) skillsExperience working in a highly matrixed environment.
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Two years’ experience in a healthcare setting with prior Medicare/Medicaid and third party billing and collections. Minimum of two years experience in an healthcare setting with prior Medicare/Medicaid and third party billing and collections.
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Maintain accurate knowledge of coding compliance and reimbursement procedures related to top Medicare Risk Adjustment HCC’s. Maintain accurate knowledge of coding compliance and reimbursement procedures related to top Medicare Risk Adjustment HCC’s.
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Familiar with Medicare home health regulations, documentation requirements, ICD-10 coding and PPS (Strongly preferred) We are Medicare certified. Familiar with Medicare home health regulations, documentation requirements, ICD-10 coding and PPS (Strongly preferred.
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The Home Health Aide is responsible for providing patients with in-home personal care and designated health related services to maintain the patient's physical and emotional well being, while following the written plan of care, Medicare/Medicaid regulations and agency policies and procedures.
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HIRING IMMEDIATLY FOR IN HOUSE & REMOTE POSTION: Licensed Insurance Agent, preferably with Medicare sales experience. We specialize in Medicare Advantage, Medicare Supplement, as well as ancillary plans, allowing us to operate year-round.
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2+ years of prior Medicare sales experience. We are currently offering a $1,500 signing bonus to all new Medicare Advisors who start before August 26th, 2024. Chapter provides the best Medicare guidance in America by breaking down barriers to information, training best-in-class Advisors, and maintaining continuous community & support.
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Speech Therapist, PRN South Pinellas Qualifications: Speech Therapist with Medicare home health experience. We are a family owned Home Health Care Agency, Inc. free Deficiency survey, operating since 1996.
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medicare job in Clearwater, FL
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